Seeking a sense of control

MANY YEARS ago I took a stroll around the block with the mother of a friend. As we walked she made sudden noises, like shots from a gun.

But when I listened carefully it seemed that the sounds were orphaned bits of words, as though her conversation were a tape and most of it had been erased, leaving only stray fricatives and glottal stops.


Perhaps the sounds were the remaining shreds of her personality, which had been taken into some dark place by a then little-known ailment called Alzheimer's disease.

This may have been the sort of life Janet Adkins feared when she lay in a Volkswagen van and pressed the button that released lethal drugs into her body.


Mrs. Adkins's doctor believed she had years to go before her self disappeared into the degenerative swamp of Alzheimer's.

But anyone who has ever encountered the disease knows its Catch 22; by the time you might want to die, you're too far gone to do anything about it.

Mrs. Adkins, a former English teacher, looked into the future and committed suicide.

If she had done so alone her story would be a small one. But she went to Jack Kevorkian, a euthanasia entrepreneur who constructed a suicide machine at home.

Mrs. Adkins used it to go quietly into that good night. And Dr. Kevorkian was charged last week with first-degree murder.

This is the sort of case prosecutors characterize as "sending a message," as though we were unruly school children waiting to throw rocks through the windows of the law.

Mrs. Adkins could have accomplished what she sought with a handgun or a tall building.

But she went to Dr. Kevorkian because she wanted a gentle death, the kind we offer now even for some of those we execute.


There is a message in this case, but it is not the one prosecutors send.

It illustrates how desperate we have become to retain some modicum of control in the face not only of horrible illness, but of medical protocols that lengthen degeneration and dying.

There are probably few Americans who, like Mrs. Adkins, want to end their lives while they are still unmarred by illness. And only one country, the Netherlands, permits physician-assisted suicide.

But there are thousands of people who find that after the chemotherapy and the surgeries and the progression of disease, they have become a macabre mockery of their selves, keeping their lives but losing their dignity.

Once a friend told me that her mother, who was suffering on the rack of ovarian cancer, had a superb oncologist. He was kind, considerate, explained all procedures thoroughly. But that was not his great virtue.

Finally she blurted out, "He told me how many of my mother's painkillers constituted a lethal dose."


There are doctors like that, who go quietly about the business of tempering science with mercy.

A pneumonia goes untreated; a new course of chemo is not tried. The American Hospital Association says 70 percent of the deaths that occur in this country include some negotiated agreement not to use life-prolonging technology.

The case of Nancy Cruzan may end soon, although her parents believe her life ended years ago.

The state of Missouri, after fighting all the way to the Supreme Court has withdrawn its opposition to having the 32-year-old woman's feeding tube removed.

Hard cases make bad law, my lawyer says, and this is one.

But hard cases sometimes illuminate hard issues. The medical profession must continue to find ways to balance its capabilities and their human costs.


The people must demand laws that allow them to participate in that balancing, laws that embody the facts of their lives.

The question of how and when we die, in an age of respirators and antibiotics and feed tubes, has become one of the great "who decides?" issues of modern times.

When Nancy Cruzan's case was being heard, people with medical war stories said: "Wheel her into the courtroom. Then they'll understand."

Perhaps that is what Janet Adkins did: placed the evidence before the judge she believed knew best, saw herself incontinent, incompetent, incapable of knowing the difference between "Tom and Jerry" and "War and Peace."

And then pronounced sentence.